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Preexisting Resistance to Nonnucleoside Reverse-Transcriptase Inhibitors Predicts Virologic Failure of an Efavirenz-Based Regimen in Treatment-Naive HIV-1-Infected Subjects.

Kuritzkes DR, Lalama CM, Ribaudo HJ, Marcial M, Meyer Iii WA, Shikuma C, Johnson VA, Fiscus SA, D'Aquila RT, Schackman BR, Acosta EP, Gulick RM

1Brigham and Women’s Hospital, Harvard Medical School, and 2Harvard School of Public Health, Boston, Massachusetts; 3Quest Diagnostics, Inc., Baltimore, Maryland; 4University of Hawaii, Honolulu; 5Birmingham Veterans Affairs Medical Center and 6University of Alabama at Birmingham School of Medicine, Birmingham; 7University of North Carolina, Chapel Hill; 8Vanderbilt University, Nashville, Tennessee; 9Weill Medical College, Cornell University, New York, New York.

A case-cohort study was used to determine the effect of baseline nonnucleoside reverse-transcriptase inhibitor (NNRTI) resistance, as assessed by viral genotyping, on the response to efavirenz-containing regimens in AIDS Clinical Trials Group A5095. The sample included a random cohort of efavirenz-treated subjects plus unselected subjects who experienced virologic failure. Of 220 subjects in the random cohort, 57 (26%) had virologic failure. The prevalence of baseline NNRTI resistance was 5%. The risk of virologic failure for subjects with baseline NNRTI resistance was higher than that for subjects without such resistance (hazard ratio 2.27 [95% confidence interval], 1.15-4.49; [Formula: see text]). These results support resistance testing before starting antiretroviral therapy.

Published 13 February 2008 in J Infect Dis.
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